Eduard Vieta1, Heinz Grunze2, Jean-Michel Azorin3, Andrea Fagiolini4. 1. Bipolar Disorder Programme, Institute of Neuroscience, University of Barcelona Hospital Clínic, IDIBAPS, CIBERSAM, C/Villarroel 170, Barcelona 08036, Catalonia, Spain. Electronic address: evieta@clinic.ub.es. 2. Institute of Neuroscience, Academic Psychiatry, Newcastle upon Tyne, NE4 5PL, UK. 3. Hospital Ste. Marguerite, 270 Bd Sainte Marguerite, 13274 Marseille, France. 4. Department of Molecular Medicine, University of Siena, School of Medicine, Siena, Italy; Department of Mental Health, University of Siena Medical Center, Siena, Italy.
Abstract
BACKGROUND: The aim of this study was to describe the phenomenology of mania and depression in bipolar patients experiencing a manic episode with mixed features as defined in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS: In this multicenter, international on-line survey (the IMPACT study), 700 participants completed a 54-item questionnaire on demographics, diagnosis, symptomatology, communication of the disease, impact on life, and treatment received. Patients with a manic episode with or without DSM-5 criteria for mixed features were compared using descriptive and inferential statistics. RESULTS: Patients with more than 3 depressive symptoms were more likely to have had a delay in diagnosis, more likely to have experienced shorter symptom-free periods, and were characterized by a marked lower prevalence of typical manic manifestations. All questionnaire items exploring depressive symptomatology, including the DSM-5 criteria defining a manic episode as "with mixed features", were significantly overrepresented in the group of patients with depressive symptoms. Anxiety associated with irritability/agitation was also more frequent among patients with mixed features. LIMITATIONS: Retrospective cross-sectional design, sensitive to recall bias. Two of the 6 DSM-5 required criteria for the specifier "with mixed features" were not explored: suicidality and psychomotor retardation. CONCLUSIONS: Bipolar disorder patients with at least 3 depressive symptoms during a manic episode self-reported typical symptomatology. Anxiety with irritability/agitation differentiated patients with depressive symptoms during mania from those with "pure" manic episodes. The results support the use of DSM-5 mixed features specifier and its value in research and clinical practice.
BACKGROUND: The aim of this study was to describe the phenomenology of mania and depression in bipolarpatients experiencing a manic episode with mixed features as defined in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS: In this multicenter, international on-line survey (the IMPACT study), 700 participants completed a 54-item questionnaire on demographics, diagnosis, symptomatology, communication of the disease, impact on life, and treatment received. Patients with a manic episode with or without DSM-5 criteria for mixed features were compared using descriptive and inferential statistics. RESULTS:Patients with more than 3 depressive symptoms were more likely to have had a delay in diagnosis, more likely to have experienced shorter symptom-free periods, and were characterized by a marked lower prevalence of typical manic manifestations. All questionnaire items exploring depressive symptomatology, including the DSM-5 criteria defining a manic episode as "with mixed features", were significantly overrepresented in the group of patients with depressive symptoms. Anxiety associated with irritability/agitation was also more frequent among patients with mixed features. LIMITATIONS: Retrospective cross-sectional design, sensitive to recall bias. Two of the 6 DSM-5 required criteria for the specifier "with mixed features" were not explored: suicidality and psychomotor retardation. CONCLUSIONS:Bipolar disorderpatients with at least 3 depressive symptoms during a manic episode self-reported typical symptomatology. Anxiety with irritability/agitation differentiated patients with depressive symptoms during mania from those with "pure" manic episodes. The results support the use of DSM-5 mixed features specifier and its value in research and clinical practice.
Authors: Andrea Fagiolini; Anna Coluccia; Giuseppe Maina; Rocco N Forgione; Arianna Goracci; Alessandro Cuomo; Allan H Young Journal: CNS Drugs Date: 2015-09 Impact factor: 5.749
Authors: Maurizio Pompili; Ross J Baldessarini; Alberto Forte; Denise Erbuto; Gianluca Serafini; Andrea Fiorillo; Mario Amore; Paolo Girardi Journal: Int J Mol Sci Date: 2016-10-11 Impact factor: 5.923